Journal of Leisurability

Transcription

1 Journal of Leisurability Volume 24 Number 2 Spring 1997 Student Perspectives Putting Some Spirit Into Recreation Services for People With Disabilities Paul Heintzman there is a difference between a worldly style of leisure and one filled with a deep sense of spirit.... We risk leisure pathology in our clients and ourselves if we believe leisure can only be bought, planned, scheduled, earned, put into a timeframe, consumed, experienced on the physical or mental plane of our ego. Leisure wellness must include the awareness and expression of one's sense of spirit.... The greatest challenge of the leisure profession as a whole, and therapeutic recreators specifically, is to know this spirit well. (McDowell, 1986, p. 37) The helping professions are increasingly recognizing the need for spirituality within their professions and practices and are adopting holistic definitions of health that explicitly include a spiritual dimension (Hawks, Hull, Thalman, & Richins, 1995). While conceptual discussions of leisure often have spiritual overtones or link leisure with spirituality, there has been little theoretical reflection on the topic until this decade (McDonald & Schreyer, 1991; Heintzman & Van Andel, 1995). In recent years, philosophical arguments have been made for the inclusion of spirituality in recreation services for people with disabilities. Howe-Murphy and Murphy (1987) suggested a New Age spirituality and paradigm in which "the development of personal consciousness, leading to a lifestyle of wellness, and which incorporates the elements of mind, body, spirit, is the essential framework for our quest as therapeutic recreators" (p. 47). Van Andel and Heintzman (1996) used the model of Christian spirituality "in which humans, created in the image of God, are viewed as a mind-body-spirit unity who have capacity to relate, not only with other human beings, but also with God" (p. 74), to illustrate how recreation practitioners might develop a more holistic approach. The authors of these two papers, which represent two of many different spiritual perspectives, stress the need to include the spiritual dimension of life in recreation services for people with disabilities. The purpose of this paper is to explore what spiritual health is from a generic perspective, how it is related to recreation services for people with disabilities, and to suggest practical implications for the implementation of recreation services and programs. Recreation and Spiritual Health Carter, Van Andel and Robb's (1995) outcome model is one model of therapeutic recreation service delivery that recognizes spiritual health and spiritual functioning. In this model, therapeutic recreation strives to sustain or enhance the health status, quality of life, and/or functional capacities of persons with disabilities through the use of recreation or experiential activities and processes specifically developed for these persons. It must be noted that within this model the term "therapeutic recreation" is

2 inclusive of all settings including community and clinical settings. Health status refers to an integration of five independent and yet interacting health dimensions - physical, mental, spiritual, emotional and social that describe a person's relative level of health and well-being. Quality of life is a subjective measure of spiritual and psychological well-being characterized by feelings of self-determination, joy, contentment, and satisfaction (Iso-Ahola, 1980). Functional capacities refer to a person's ability to function socially, spiritually, psychologically or emotionally, physically, and mentally or cognitively. Thus, the spiritual dimension is important in all three components of the outcome model-health status, quality of life and functional capacities. I will look at the spiritual dimension of each of these components in more detail. Health Status Traditionally health status has alluded to physiological measures used by medical practitioners to determine physical health, such as pulse rate and blood pressure. However, the World Health Organization's definition of health, a continuum which includes social, emotional, spiritual, and mental health, in addition to physical health, is more appropriate because it acknowledges the complexities of the human organism and the dynamic interrelationship between body, mind, and spirit. Holistic health is used to describe this integration of body, mind and spirit. Hawks et al. (1995) noted that the spirit, mind and body may be "interconnected, inseparable, and simultaneously interacting with each other on numerous levels." Research suggests that individuals who attain integration among life's domains can experience a high level of well-being, despite their circumstances. Carter et al. (1995) gave the example of a person with AIDS or comparable terminal illness who exhibits poor physical health, but experiences a high degree of wellness characterized by mental alertness, appropriate emotional expression, maintenance of meaning and purpose in life, and good relationships with others. Thus, in spite of poor physical health, the person is maintaining an optimal level of wellness. Gartner, Larson & Allen (1991) found that the ability to maintain an optimal level of wellness is particularly true for religious individuals with a strong faith commitment. This finding may suggest the importance of spiritual health in overall optimal wellness. As a health or wellness dimension, spirituality has been conceptualized from two perspectives, an elementalistic and an integrative. As an elementalistic dimension, spiritual wellness is viewed as one of the dimensions, while as an integrative dimension it is an over-arching concept found within each of the other dimensions. From the elementalistic view, spiritual wellness, as one part of the whole, must remain in balance with each of the other dimensions if optimal wellness is to be maintained. From the integrative view, optimal wellness is dependent upon spiritual wellness occurring within each of the interrelated and interactive dimensions of wellness. If spiritual wellness is an integrative component, and not just an elementalistic component of wellness, then it needs to be an important consideration in recreation services. Quality of Life Quality of life, as defined above, is very much associated with spiritual well-being and personal characteristics such as selfdetermination, joy, contentment and satisfaction

3 (Carter et al., 1995). The degree to which this understanding of quality of life overlaps with spirituality can be illustrated by the following definition of spiritual health: Optimal spiritual health may be considered as the ability to develop our spiritual nature to its fullest potential. This would include our ability to discover and articulate our own basic purpose in life, learn how to experience love, joy, peace and fulfillment and how to help ourselves and others achieve their full potential. (Chapman, 1987a, p. 32) The quality of life outcome is extremely significant because it touches upon the heart of what it means to be human, and thus it is within this context that a person is viewed holistically rather than as having a dysfunctional part which requires therapy (Carter et al., 1995). As arguments continue to be made for the rejection of the medical model in recreation services for people with disabilities, and for quality of life to be the central focus ($ylvester, 1996), it is imperative that the spiritual dimension of life be recognized. Functional Capabilities The third outcome in this model involves an individual's ability to function in each of the five domains of health status. Recreation activities are designed to improve functional capacities of persons with specific disabilities. Often recreation involves the evaluation and handling of broader areas, for example, lifestyle management or leisure attitudes and behaviourswhich affect multiple domains (Carter et al., 1995). Again, the spiritual dimension is crucial to these recreation activities, as there is evidence to suggest that spirituality plays an important role in outcomes in other health domains. Hawks et al. (1995) reviewed three health programs in which program components of a spiritual nature (e.g. group support, meditation, yoga, forgiveness, prayer, and mindful awareness) had an influence upon spiritual, behavioural and health outcomes. They suggested that observed physical and emotional health outcomes may be the final product of a causal chain of relationships that start with spiritual components. Therefore, attention to the spiritual dimension, as a significant factor in influencing functional capabilities, needs to be given greater emphasis by human service professionals, including those involved in recreation services for people with disabilities. Hawks et al. suggest that techniques such as meditation, imagery, and group support, techniques sometimes used in recreation services for people with disabilities, be viewed within a wider framework as a means to improve spiritual health components such as meaning and purpose in life, connectedness with others, and self-awareness, rather than simply stress reduction techniques that help people escape their problems or calm them down. What is Spiritual Health? Since spiritual health has no definitive parameters, structure, or measurable subcomponents (Eberst, 1984), it has been characterized as the most difficult dimension of health to define and measure (Banks, 1980). Thus there is not a single recognized definition of spiritual health (Bensley, 1991). However, with increasing scientific interest in spirituality, there seems to be enough consensus to attempt a definition. Based on a synthesis of extensive literature, Hawks (1994) has identified a number of the internal and external characteristics of spiritual health which consistently appear in the

4 literature on this topic: A. Internal characteristics of those who are spiritually well: life purpose and ultimate meaning, oneness with nature and beauty and a sense of connectedness with others deep concern for and commitment to something greater than self a sense of wholeness in life strong spiritual beliefs, principles, ethics, and values love, joy, peace, hope, and fulfillment B. External characteristics of those who are spiritually well: trust, honesty, integrity, altruism, compassion, service regular communion or a personal relationship and experience with a higher power or larger reality that transcends an observable physical reality (Hawks, 1994, p. 4) Building upon the above characteristics of spiritual health Hawks (1994) developed the following short, but comprehensive definition of spiritual health: A high level of faith, hope, and commitment in relation to a well-defined worldview or belief system that provides a sense of meaning and purpose to existence in general, and that offers an ethical path to personal fulfillment which includes connectedness with self, others, and a higher power or larger reality. (p. 6) This inclusive definition of spiritual health is broad enough to be applicable to the various world views and belief systems that exist in our culturally and religiously pluralistic society (Hawks et al., 1995). What Factors Enhance Spiritual Health? Following from his definition of spiritual health, Hawks (1994) identifies three factors which contribute to spiritual health. The first factor is "a well-defined worldview or belief system that provides purpose, meaning, and motivation to life" (p. 5). Spiritually healthy persons have a coherent worldview which interprets reality for them and provides a consistent belief system. The worldview answers questions such as "where did I come from," "why am I here," "how do I find meaning and fulfillment in life, " and "what will happen when I die" (Brower, 1984). Usually these questions are explained in relation to a larger reality or a higher power. By explaining these questions, the worldview offers a sense of purpose and meaning to life and a path for personal fulfillment which provides beliefs, values, as well as rules of conduct and a sense of moral ethics (Hawks, 1994).

5 The second factor contributing to spiritual health is "selflessness, connectedness with, and concern for others" (Hawks, 1994, p. 5). Honesty, integrity, selflessness, compassion and connectedness with others are the characteristics of spiritual health found in most reviews of spirituality (Banks, 1980; Elkins, Hedstron, Hughes, Leaf, & Saunders, 1988; Poehler, 1982; Russell, 1984). Persons who focus on pleasure-seeking and self-gratification, as opposed to selflessness, are more susceptible to unhappiness, a sense of emptiness, mood disorders, and addictions, all of which are contrary to spiritual health characteristics (Hawks, 1994). Research suggests a negative relationship between spiritual well-being and self-oriented constructs such as personal freedom, success orientation, and individualism (Ellison, 1983). Meanwhile, many positive health outcomes have been associated with connectedness with others (House, Landis, & Umberson, 1988; Kaplan, Salonen, Cohen, Brand, Syme, & Puska, 1988). The third factor enhancing spiritual health is "high levels of personal faith and commitment in relation to the worldview and belief system" (Hawks, 1994, p. 5). Spiritual health is dependent not only on intellectual knowledge of a world view, but on an ability to live out that perspective and model it for others. Without a personal sense of belief, hope, and faith, the motivation and level of commitment required to follow the path outlined by the worldview would not be realized. Faith and hope are necessary for a person to be empowered to be selfless, compassionate and caring. With commitment, hope and faith, the quest for meaning and purpose, as prescribed by the worldview, can assist the person to achieve high levels of spiritual health and the associated connectedness with others, self-esteem, and personal fulfillment. Given the above three factors which contribute to spiritual health, recreation services could enhance spiritual health through: (1) programs and strategies (e.g. leisure education, values clarification) which provide opportunity to investigate diverse belief systems and world views in a personal quest for truth, purpose, and meaning; (2) occasions (e.g. social skills training, resocialization activities, group activities, outdoor activities) for cultivating and enhancing relationships and a feeling of connectedness with self, other persons, the world, and a larger reality or a higher power; and (3) activities (e.g. expressive activities such as art, creative writing, dance and drama) that assist a participant in appreciating his or her unique potential and identifying the course which will lead to the achievement or fulfillment of that potential (Hawks et al., 1995). Why Include a Spiritual Health Component In Recreation Services? There are a number of reasons for including the spiritual dimension in recreation services for people with disabilities. First, inclusion of a spiritual health component would broaden the motivational and value base of recreation services that focus on functional capacities or physical health. Second, it would enhance the richness of recreation services, and if done properly, would potentially increase the satisfaction levels of program participants. Third, the spiritual dimension could enable recreation services to become more effective agents of behavioural change by acknowledging and working with a wider range of issues important to a person's behavioural choices. Fourth, and related to the above three reasons, the spiritual dimension can possibly help restore balance between a narrow health status emphasis and a more holistic and

6 comprehensive quality of life perspective. Fifth and finally, through addressing spiritual health issues, recreation services could possibly be more effective in enhancing quality of life issues at organizational, agency, and community levels. In summary, exploration of the spiritual dimension of life within the context of recreation services helps balance quality of life concerns with services that improve health status and enhance functional capabilities (Chapman, 1987a). How to Enhance Spiritual Health Through Recreation Services Development of spirituality includes such areas as "self-awareness, self-inquiry, search for knowledge, behavior change, cognitive restructuring, relational skills, life goal planning", lifestyle assessment and management, stress management, time management, wellness programs, and behaviour change/motivation strategies (Chapman, 1987a, pp. 32, 37). Many of these areas are addressed within recreation services for people with disabilities. Spiritual health issues may be integrated into recreation services for persons with disabilities at three basic levels: (1) the overall program; (2) existing program activities; and (3) separate program activities focused completely on spiritual health. We will briefly look at each of these three areas. A. Including Spiritual Health in Program Objectives, Themes, Promotion, and Management Chapman (1987b) has identified a number of ways that spiritual health questions can be integrated into health promotion programs. A number of these approaches can be adapted to recreation services for persons with disabilities. 1. Formally recognize and use a definition of health which includes a spiritual dimension. This recognition acknowledges that human beings are a physical, mental, and spiritual unity. For example, recreation services at the Homewood Alcohol and Drug Service in Guelph, Ontario view health as a "state of physical, psychological, social and spiritual well-being." Intervention, in the form of recreation activities, takes place in these domains to bring about behavioural change and to develop leisure skills so that individual growth is promoted (Baker, Harding & Hadwen, 1994, p. 23). 2. Mention spirituality, spiritual health, or spiritual dimension in a program's publicity materials used to market the program and inform potential participants. To return to the example of the Homewood Alcohol and Drug Service, publicity for this program mentions spirituality and spiritual guidance. 3. Use program themes such as "Growing in Body, Mind and Spirit" or "Pathways to Fulfillment" that involve spiritual health issues. Group discussions could involve topics such as how to develop a sense of meaning and purpose in life. 4. Include spiritual health references in program communication materials such as motivational posters, newsletter articles and program handouts. 5. Integrate spiritual health issues into staff management processes and meetings. Implementation of a staff philosophy which builds on character qualities such as service, integrity, and personal excellence raises awareness of spiritual health issues.

7 B. Incorporating Spiritual Health into Existing Programs There are many ways that spiritual health issues can be integrated into the existing recreation program components or strategies. A few examples will be described. It must be noted that these issues and programs are not unique to persons with disabilities. However, as McAvoy and Lais (1996) note, it is the starting place that is different for persons with disabilities. Given "the realities of a disability and the societal attitudes that place limits on those with disabilities" (p. 356), the spiritual dimension is just that much more precious. 1. Needs Assessment Spiritual health related questions may be added to needs assessments and interest surveys (for examples of questions see Chapman, 1986, 1987a). Such questions can be used to raise awareness about spiritual health issues. As a result, spiritual health objectives may become part of the resultant recreation strategy. 2. Leisure Education and Values Clarification An important element of recreation services for people with disabilities is leisure education and the related process of values clarification wherein one identifies and defines the personal beliefs that guide an individual's behaviours. This exploration and clarification of basic beliefs and values "may contribute to improved leisure satisfaction and quality of life" (Carter et al., 1995, p. 100). Such leisure education and values clarification aids in the process of worldview development which, as we have seen, is an important contributing factor to spiritual health. 3. Stress Management Since the negative effects of stress are common among those who experience disabilities, recreation programs for persons with disabilities that focus on health prevention and health promotion often include techniques for stress education and management (Carter et al., 1995). Spiritual health issues can be explored in discussions of stressors, stress reduction methodologies, and issues of commitment, control and challenge. Discussion groups and self-quizzes are appropriate methods to introduce these issues. 4. Time Management The focus on priority-setting in time management discussions is suitable for the incorporation of spiritual health issues and questions. Daily goals and objectives need to be balanced with longer term goals and objectives. Use of "life map, scenario building" and "treasure map" techniques are ways of introducing spiritual health issues (see Chapman 1987a). 5. Outdoor Recreation Programs There are a number of spiritual benefits or values related to interaction with the natural environment (McAvoy and Lais, 1996). Selected readings, planned relaxation/reflection times or symbolic rituals on hikes, walks and other outdoor activities are ways of introducing spiritual health issues into these activities. 6. Behaviour Modification and Behavioural Support Groups Many recreation services involve assisting persons with disabilities to change or modify some aspect of their attitudes, values, and/or behaviours (Carter et al., 1995). Spiritual resources are important in making and maintaining these

8 changes. A good example is the importance of spirituality within A.A. and related programs. Spiritual health issues can be explored as part of the discussion topics in support groups. 7. Humour Humour is a strategy to reduce anxiety and create optimal conditions for healing and thus help individuals fight the negative consequences of disease, treatment, and hospitalization (Carter et. al, 1995). Reading of humorous poems or writings with spiritual overtones is one way to help persons address spiritual health issues. Humour, which represents the world of the possible, may also be of benefit to persons with disabilities as they struggle to be accepted and included (Guilmette, 1996). 8. Social Integration Social skills deficits are prevalent among individuals with traumatic brain injuries, chronic mental illnesses and developmental disabilities. Through social skills training, these individuals develop basic social and interpersonal skills needed to function in society (Carter et. al., 1995). Meanwhile, individuals with chronic illnesses or those in geriatric settings often experience isolation and diminished levels of social functioning. Resocialization activities enhance interpersonal skills, revitalise interest in life events and activities, and encourage a concern for the quality of life for others (Carter et al.). Group activities provide the opportunity to develop social skills and to become connected with others. Social skills training, resocialization, and group activities all enhance social integration which has a spiritual dimension "because it is concerned with the sense of interpersonal intimacy, social support, and the deepening of relationships" (McAvoy & Lais, 1996, p. 353). C. Programs Dedicated Exclusively to Spiritual Health In a few cases, recreation programs might offer programs exclusively focused on spiritual health. These could include personal awareness workshops, spiritual renewal seminars/retreats, spiritual health support cases, spiritual health oriented lending libraries and spiritual health workshops (Chapman, 1987b). However, in most cases, recreation professionals would refer persons to these types of program offered by other organizations such as religious institutions and retreat/spirituality centres. Conclusion This paper has discussed the role of spiritual health in recreation services for people with disabilities. Spiritual health has been defined and discussed within the context of the outcome model. Factors that enhance spiritual health have been reviewed, reasons for including a spiritual health component in recreation services have been outlined, and a number of practical suggestions for enhancing spiritual health through recreation have been offered. In conclusion, I return to the quotation from McDowell (1986) with which I began this paper: Plan to touch this spirit at will, embracing it within your bodymind. Do anything you can to discover it deeply within yourself and your clients and to arouse its energy. What you will discover is that this spirit is the life force energy behind the hope and will that

9 heals and keeps one well. It is what makes leisure Leisure, not as something you do, but as something you feel deeply inside (1986, p. 37). References Baker, J.K., Harding, S.C., & Hadwen, D.K. (1994). The role of recreation therapy in the treatment of chemical dependency: An analysis of the Homewood Alcohol and Drug Service. Journal of Leisurability, 21(1), Banks, R. (1980). Health and the spiritual dimension: Relationships and implications for professional preparation programs. Journal of School Health, 50(4), Bensley, R.J. (1991). Defining spiritual health: A review of the literature. Journal of Health Education, 22(5), Brower, I.C. (1984). The 4th ear of the spiritually sensitive social worker. The union for experimenting colleges and social workers, Ph.D. dissertation. (University Microfilms International No ). Carter, M.C., Van Andel, G. E., & Robb, G.M. (1995). Therapeutic recreation: A practical approach.prospect Heights, IL: Waveland Press. Chapman, L.S. (1986, Summer). Spiritual health: A component missing from health promotion. American Journal of Health Promotion, 1, Chapman, L.S. (1987a, Winter). Developing a useful perspective on spiritual health: Well-being, spiritual potential and the search for meaning. American Journal of Health Promotion, 1, Chapman, L.S. (1987b, Fall). Developing a useful perspective on spiritual health: Love, joy, peace and fulfillment. American Journal of Health Promotion, 2, Eberst, R. (1984). Defining health: A multidimensional model. Journal of School Health, 54(3), Elkins, D.N., Hedstron, L.J., Hughes, L.L., Leaf, J.A., & Saunders, C. (1988). Toward a humanistic-phenomenological spirituality: Definition, description, and measurement. Journal of Humanistic Psychology, 28(4), Ellison, C.W. (1983). Spiritual well-being: Conceptualization and measurement. Journal of Psychology and Theology, 19(1), Gartner, J., Larsen, D.B., Allen, G.D. (1991). Religious commitment and mental health: A review of the empirical literature. Journal of Psychology and Theology, 19(1), Guilmette, A.M., (1996). Humour [Special issue]. Journal of Leisurability, 23(4).

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11 II). Arlington, VA: National and Recreation Park Association. Van Andel, G., & Heintzman, P. (1996). Christian spirituality and therapeutic recreation. In C. Sylvester (Ed.) Philosophy of therapeutic recreation: Ideas and issues (Vol. II), (pp. 7185). Arlington, VA: National Recreation and Park Association. * Paul Heintzman is a Ph.D. Student in the Department of Recreation and Leisure Studies, University of Waterloo, Waterloo, Ontario. Paul has work experience in recreation, human services and environmental fields.